Huge waste-DALY in India

A recent news report brings out a terrifying picture of the status of heart disease and stroke attacks in India.

 

 

 

The report  brings out the fact that heart disease deaths have increased by 34% in India during a span of 15 years,while it decreased by 41% in USA.

The report also points out that there is significant difference in the occurrence of the diseases among the states.This may help us to understand the issues better.

Below you will find some data about the three states mentioned in the report. The states are Mizoram,Punjab and West Bengal.

Parameters/           States -> Mizoram Punjab West Bengal
Literacy rate 91.33% 75.84% 76.26%
Sex ratio 976 895 950
Forest area 88.93% 6.87% 13,38%
Tribal population as per cent of total population 94.5% Annual reports

(2003-04) of union ministry of
tribal affairs denies the existence of tribal population.  Patiala based Punjabi university gave no. count of ex-criminal tribes as 4.37lakhs, total population is more than 277 lakhs.

About 6%

Table-1

According to the report,Punjab has the highest DALY related to cardiovascular disease, Mizoram has the lowest.DALY score of West Bengal is sixtimesthat of Mizoram. DALY means ‘ Disability Adjusted Life Years’. It is a measure of the burden of disease resulting from disability and morbidity.WHO has introduced it and ways of calculating DALY. Simply speaking, higher the DALY score worse is the state of health,greater is the burden.

It is significant that Mizoram,a small state in India has the lowest DALY compared to Punjab and West Bengal.At the same time literacy rate,sex ratio, forest cover and tribal population in Mizoram are much much better than West Bengal and Punjab.

Do these facts suggest something?

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what is normal and what is high blood pressure?

NORMAL & HIGH BLOOD PRESSURE:

It is difficult to define high blood pressure or hypertension.

Blood pressure varies from one healthy individual to another.For the same individual, blood pressure depends on the time of the day,season of the year, state of mental stress or physical exercise.

Professor Desmond G. Julian writes in ‘Cardiology'(third edition, 1979):

The mean pressure during sleep may be 30 to 40 mm Hg lower than it is in the waking state.Factors which transiently increase pressure include anxiety and cold.Exercise leads to a rise in both systolic and diastolic pressures. A transient doubling of pressure may occur at the climax of coitus.

In addition, the existence of ‘white coat hypertension’ makes the situation more complex.The blood pressure .However of an individual measured at a conventional clinic may be 10-15 mm Hg greater than the value measured at the relaxed atmosphere of home.

Previously,blood pressure was regarded to be abnormally high if it persistently exceeded 140/90 mm of Hg

However,American Heart Association(AHA) 2017 guidelines seek to lower the numbers involved in the definition of high blood pressure.They eliminated the previous category of pre hypertension (Systolic Blood Pressure,SBP in the range 120-129 and diastolic<80). According to them blood pressure categories are:

  • Normal:BP less than 120/80
  • Elevated: SBP 120-129  and DBP <80
  • Stage1:SBP 130-139 or  DBP 80-89.
  • Stage2:SBP: at least 140 or diastolic at least 90.
  •  Hypertensive crisis:: SBP  over 180 and/or DBP 120.

AAFP(American Academy of Family Physicians) has decided to not endorse the recent guidelines for its over dependence on SPRINT(Systolic Blood Pressure Intervention trial and also because of the possibility of over treatment. Earlier, 2016 European Guidelines on CVD prvention did not directly endorse SPRINT trial says it may be prudent toto recommend lowering  SBP/DBP to values within the range 130-139/80-85

Indian Guidelines:

Journal of the Association of Physicians in India (JAPI) noted in 2013 that some evidence exist to indicate that the risk of Cardiovascular events in Indians is higher at relatively lower levels of blood pressure.In ‘Best Practices of Hypertension-2017’-(P.C. Manoria et al) gives the criteria for diagnosing hypertension  as :

  • Office B.P: Systolic >=140, diastolic:>=90
  • Home B.P: Systolic>=135, diastolic>=85